I have to admit that I cannot improve much upon the following outline and that I agree with most of it. This kind of work is why I am going to participate in and later speak at the Becker’s Review CEO forum. Pay particular attention to #6 through #8. The other insights are interesting mostly because they are applicable to the mega systems and have been one of the ways I evaluate whether a given mega system is going to get it or get hit.
Here are eight contemporary insights for hospital and health system leaders from the Advisory Board, which collected these ideas during its CEO Special Sessions.
1. Accept the idea that price/high reimbursement is no longer a strategy for growth. Previously, hospitals consistently received price increases that outpaced inflation. Four market trends are signaling the end of this strategy, according to the Advisory Board:
• Direct and implicit reimbursement cuts from the Patient Protection and Affordable Care Act and sequestration.
• Limited offsets from coverage expansion.
• The dilution of employer-sponsored coverage and increase in high-deductible health plans.
• Patient preference for low-cost sites of care, such as retail clinics.
2. Transition from extractive to productive growth. Hospitals can no longer rely on growth strategies that focus on consolidating their market position, locking up referral streams or demanding price increases. Instead, hospitals are entering a new era of what the Advisory Board calls "productive growth" — earning market share by attracting empowered purchasers. This includes:
• Network suppliers, such as physicians, post-acute providers and capital partners.
• Wholesale buyers, such as commercial payers, employers and physician accountable care organizations.
• Clinical shoppers, or physicians and patients making decisions about individual episodes of care.
3. Re-position growth as an output instead of as an input. Traditionally, hospital leaders often justified growth as an input. Growth advanced a larger cause, such as funding innovation or extending the hospital's mission. But under productive growth, in which purchasers selectively buy care in a competitive market, the Advisory Board says leaders should re-position their understanding of growth as output rather than an input. Hospitals that grow are doing something right; hospitals that don't are failing.
4. Create three complementary care models. Savvy hospital leaders understand the subgroups within population health. The Advisory Board says there are three:
• High-risk patients with complex diseases and co-morbidities. This subgroup makes up about 5 percent of patients. Hospitals should take a comprehensive and proactive approach to care management to avoid high-cost acute-care services when possible.
• Rising-risk patients who may have medical conditions that are not under control. This subgroup makes up about 15 percent to 35 percent of patients. Providers should avoid unnecessary spending on these patients and keep them from becoming high-risk.
• Low-risk patients, who have minor conditions that are easily managed and account for 60 percent to 80 percent of patient populations. Hospitals should keep these patients healthy but loyal to the system when they need care.
5. Define population health goals. Develop a short list of actionable and measurable goals. They should be narrowly defined and unambiguous. Ensure each member of the organization understands how they contribute to the goals.
6. Ensure high-risk patients have care managers. The Advisory Board says high-risk patients' most important relationship is that with their care managers, not primary care physicians. Dedicated care managers can coordinate the diverse needs of high-risk patients, which span from clinical to nonclinical and may demand more help than PCPs can offer.
7. Manage "rising-risk" patients in the medical home. Nine risk factors, such as obesity and smoking, make a patient a fit in the rising-risk category. Hospitals should identify these patients and connect them to a medical home, which offers a balance of customized support and scale necessary to manage this population with limited resources.
8. Ensure access for healthy patients. Hospitals don't want too many encounters with their low-risk patients, but they must offer accessibility when the time for care comes. Hospitals also need to foster loyalty among these patients. "Mainly, you need to provide timely access to evidence-based preventative care," wrote the Advisory Board. "We've also seen organizations turning to patient portals to offer convenient options such as online scheduling and the ability to email a physician."
Monday, September 16, 2013
Friday, September 6, 2013
Hospital cuts are hitting fast and furious
I am not trying to scare everyone, but we all need to stay informed about what is going on in our industry. It is not pretty out there. If you have been listening to me rant, you know the healthcare industry is no longer the inflationary spending beast hell bent on wrecking the economy that it was according to the talking heads urging reform. For more than a generation, healthcare spending was increasing faster than the rest of the U.S. economy by a factor of two or three times. Beginning in 2009 and continuing through the first half of 2013, nation-wide healthcare spending was keeping pace with growth in the gross domestic product—but no more than that. In fact, spending per person is actually down. The 2.7% annual increase in overall spending is due to population increase.
Despite that fact, the pace of reform has not abated—if anything, it has increased. Modern Healthcare recently ran a cover story entitled, “Death by a Thousand Cuts.” The title says it all. Change is coming fast and furious. The healthcare industry needs a chance to catch its collective breath. I am afraid that we are all going to wake up in a year or two and discover that we have effectively disabled one of the few significant sectors of the U.S. economy that had been thriving. As weak as the “recovery” has been, it is a good way to trigger a second recession.
So, I will continue to pass along information as I receive it about facilities closing, cutting costs and laying off employees. According to the most recent seasonally adjusted data from the Bureau of Labor Statistics, hospitals cut 4,400 jobs during July. Becker’s Review reported the following on August 1, August 15 and September 4:
August 1:
1. Sound Shore Health System to Lay Off Nearly 2,000
Sound Shore Health System in New Rochelle, N.Y., which filed for bankruptcy in May, plans to lay off 1,993 employees. The system notified the New York State Labor Department of its layoff plans. The cuts will affect employees at Sound Shore Medical Center in New Rochelle, Mount Vernon (N.Y.) Hospital, the Helen and Michael Schaffer Extended Care Center in New Rochelle, Mount Vernon Housing Corp. in Mount Vernon and New Rochelle Sound Shore Housing.
2. Interfaith Medical Center in Brooklyn Sends Layoff Notices to All 1,544 Employees
Financially beleaguered Interfaith Medical Center in Brooklyn, N.Y., sent layoff notices to all 1,544 of its employees and asked a bankruptcy court to approve its closing. A hearing on the closing of the hospital will be held Aug. 15.
3. Denver Health to Slash 300 Jobs
Denver Health will cut roughly 300 jobs in the next year through layoffs, attrition and reduction in new hires. In all, the workforce reduction will shrink Denver Health's workforce by 5 percent.
4. Vanderbilt University Medical Center Braces for More Staff, Budget Cuts
Nashville, Tenn.-based Vanderbilt University Medical Center recently cut more than 300 members from its staff, and further budget and staff cuts are on their way at VUMC. VUMC officials have set a goal of saving $100 million in its new fiscal year, and an additional $150 million in the following fiscal year. These cost savings will be achieved through cutting costs in areas like supplies, facilities and contract improvements, and also through labor cuts like offering early retirement, leaving vacant positions empty, implementing a hiring freeze and instituting layoffs.
5. Baptist Health in Arkansas to Lay Off 170
Little Rock, Ark.-based Baptist Health laid off 170 employees. The system cited lower reimbursement, increasing charity care and bad debt as the reasons for the cuts.
6. Danbury, New Milford Hospitals Cut 116 Jobs
Danbury (Conn.) Hospital and New Milford (Conn.) Hospital's parent network, Western Connecticut Health Network, cut 116 jobs, resulting in 65 layoffs.
7. Excela Health to Lay Off 78
Greensburg, Pa.-based Excela Health is laying off 78 and leaving an additional 58 positions empty. Excela attributed the workforce reduction to lower patient volumes and revenue.
8. St. Joseph Health to Lay Off 37
Orange, Calif.-based St. Joseph Health plans to lay off 37 employees across two hospitals. The layoffs will affect 26 employees at Santa Rosa (Calif.) Memorial Hospital and 11 employees at Petaluma (Calif.) Valley Hospital.
9. Blue Mountain Health System Lays Off 16
Blue Mountain Health System, a two-hospital system with campuses in Palmerton, Pa., and Lehighton, Pa., laid off 16 employees and eliminated 13 empty positions. Additionally, the system cut the hours of seven employees, and senior management and department directors took a pay cut.
10. Providence St. Peter Hospital Cuts Number of Licensed Practical Nurses
Olympia, Wash.-based Providence St. Peter Hospital is laying off nine licensed practical nurses. The layoffs are part of an internal restructuring at the hospital. Officials decided a registered nurse with a certified nursing assistant could handle patient care in certain units.
August 15:
1. Maine Medical Center to Slash 225 Positions
Portland-based Maine Medical Center announced it will lay off 50 employees and eliminate 175 other positions. In addition to the eliminated positions and layoffs, 120 employees took an early retirement package.
2. Mountain States Health Alliance to Chop 200 Jobs
Mountain States Health Alliance in Johnson City, Tenn., is cutting 200 jobs through attrition. System officials pointed to shrinking revenues, tied to the federal sequester and lack of state officials' agreement over Medicaid expansion, as the reason for the workforce reduction.
3. WakeMed to Lay Off Hundreds, Close Nursing Home
WakeMed Health & Hospitals in Raleigh, N.C., is laying off more than 100 employees, mostly through the closure of a nursing home in Fuquay-Varina, N.C. WakeMed will also cut the jobs of 14 staff interpreters as it outsources its interpretation services. All together, WakeMed will lay off 111 employees.
4. Northside Medical Center in Ohio to Lay Off 77
Northside Medical Center in Youngstown, Ohio, an affiliate of ValleyCare Health System of Ohio in Youngstown, is laying off 77 employees.
5. Alameda Health System to Lay Off Dozens
Oakland, Calif.-based Alameda Health System prepared to lay off about 57 workers. The layoffs will affect employees at all seven of the system's locations, including a psychiatric hospital and wellness clinics.
6. Lowell General Lays Off 34
Lowell (Mass.) General Hospital laid off 34 workers. Twenty-nine of the affected employees held administrative positions, while the remaining five were nurses and caregivers.
7. Samaritan Medical Center Lays Off 23
Samaritan Medical Center in Watertown, N.Y., announced a workforce restructuring plan that will lead to 23 layoffs. Of the 23 employees who will be laid off, six are in management and 17 are in non-management positions. In addition to the layoffs, about 42 staff members will be reassigned to other jobs that are currently vacant.
8. Ukiah Valley Medical Center Cuts Jobs, Employee Hours
Ukiah (Calif.) Valley Medical Center eliminated six positions and is leaving five positions vacant. Additionally, five positions will have a reduction in hours.
9. Anna Jaques Hospital Lays Off 9 Workers
Newburyport, Mass.-based Anna Jaques Hospital laid off nine employees. The layoffs represent the loss of roughly six full-time equivalent positions.
10. Hancock Medical Center in Mississippi Lays Off 8
Bay St. Louis, Miss.-based Hancock Medical Center laid off eight employees and cut the hours of an unspecified number of other employees.
11. Orlando Health Layoffs Continue
Orlando Health confirmed more employees will be laid off as part of a restructuring the system announced in November. No specifics on how many employees would be laid off in this phase have been released.
September 4:
1. PeaceHealth to Slash 500 Jobs: Vancouver, Wash.-based PeaceHealth plans to eliminate 500 jobs throughout its system through layoffs, attrition and reduced hours. Most of the jobs being cut will be from two hospitals in southwest Washington State: Southwest Medical Center in Vancouver and St. John Medical Center in Longview. Of the 340 positions being eliminated from the two hospitals, 177 will be lost through layoffs.
2. King's Daughters Medical Center Lays Off 148: Ashland, Ky.-based King's Daughters Medical Center laid off 148 workers in support, administrative and supervisory positions. The workforce cuts were made due to declining patient volumes and reimbursement cuts.
3. Centra Notifies 124 Employees Affected by Layoffs: Lynchburg, Va.-based Centra notified 124 employees they will be laid off. By Sept. 5, 112 employees will have been laid off, and 12 more will be gone by the end of the year.
4. NorthShore to Lay Off About 100 Workers: Evanston, Ill.-based NorthShore University HealthSystem announced plans to lay off 1 percent of its workforce, roughly 100 people. The layoffs are part of an effort to "address redundancies and realign staff," according to a NorthShore memo.
5. Baptist Memorial Health Care Lays Off 23, With More Layoffs Coming: Memphis, Tenn.-based Baptist Memorial Health Care laid off 23 managers, and announced a second round of layoffs affecting 61 additional employees. Baptist pointed to increased charity care and lower reimbursements from the government as the reason for the first round of layoffs.
6. Arnot Health to Eliminate 83 Positions at St. Joseph's Hospital: Elmira, N.Y.-based Arnot Health announced it will eliminate 83 full-time equivalent positions at St. Joseph's Hospital in Elmira in September. Arnot Health is transitioning St. Joseph's to focus more on outpatient care, psychiatric and alcohol/drug addiction treatment, long-term care and chronic care. Some units will be closed or consolidated as part of the transition, leading to the elimination of positions.
7. HMA's Tennova to Cut 75 Jobs: Tennova Healthcare, based in Knoxville, Tenn., plans to lay off 75 employees in October. Affected employees work in one of the system's regional service centers in the Physicians Regional Hospital in Knoxville. Naples, Fla.-based Health Management Associates owns Tennova, and is consolidating the Knoxville regional service center into a center in Arkansas.
8. Mission Health to Lay Off Dozens, Cut Budget: Asheville, N.C.-based Mission Health plans to lay off about 70 employees and make other employee-related budget cuts. In addition to the layoffs, the system eliminated three vice president positions, did away with merit increases for 2014 and froze paid time off accruals, among other cuts.
9. Covenant Health to Lay Off 49: Covenant Health in Lubbock, Texas, plans to lay off 49 employees as part of a workforce reduction strategy. The layoffs stem from reduced reimbursements due to healthcare reform and the sequester's cuts to Medicare.
10. Columbus Regional Healthcare System Axes 4% of Workforce: Columbus Regional Healthcare System in Whiteville, N.C., eliminated 28 jobs, or 4 percent of its workforce. Ten of the 28 positions were vacant.
11. Windber Medical Center Restructures Workforce, Lays Off 19: Windber (Pa.) Medical Center laid off 19 employees and is leaving 11 positions vacant in an effort to reorganize its workforce in order to prepare for the future of healthcare. The layoffs are not linked to lower patient volumes. The workforce reorganization will create four new positions at WMC.
12. CHS' Crestwood Medical Center Lays Off 13: Huntsville, Ala.-based Crestwood Medical Center laid off 13 employees, about 1 percent of its total workforce. Affected employees were in administrative and support positions. Crestwood is owned by Franklin, Tenn.-based Community Health Systems.
Despite that fact, the pace of reform has not abated—if anything, it has increased. Modern Healthcare recently ran a cover story entitled, “Death by a Thousand Cuts.” The title says it all. Change is coming fast and furious. The healthcare industry needs a chance to catch its collective breath. I am afraid that we are all going to wake up in a year or two and discover that we have effectively disabled one of the few significant sectors of the U.S. economy that had been thriving. As weak as the “recovery” has been, it is a good way to trigger a second recession.
So, I will continue to pass along information as I receive it about facilities closing, cutting costs and laying off employees. According to the most recent seasonally adjusted data from the Bureau of Labor Statistics, hospitals cut 4,400 jobs during July. Becker’s Review reported the following on August 1, August 15 and September 4:
August 1:
1. Sound Shore Health System to Lay Off Nearly 2,000
Sound Shore Health System in New Rochelle, N.Y., which filed for bankruptcy in May, plans to lay off 1,993 employees. The system notified the New York State Labor Department of its layoff plans. The cuts will affect employees at Sound Shore Medical Center in New Rochelle, Mount Vernon (N.Y.) Hospital, the Helen and Michael Schaffer Extended Care Center in New Rochelle, Mount Vernon Housing Corp. in Mount Vernon and New Rochelle Sound Shore Housing.
2. Interfaith Medical Center in Brooklyn Sends Layoff Notices to All 1,544 Employees
Financially beleaguered Interfaith Medical Center in Brooklyn, N.Y., sent layoff notices to all 1,544 of its employees and asked a bankruptcy court to approve its closing. A hearing on the closing of the hospital will be held Aug. 15.
3. Denver Health to Slash 300 Jobs
Denver Health will cut roughly 300 jobs in the next year through layoffs, attrition and reduction in new hires. In all, the workforce reduction will shrink Denver Health's workforce by 5 percent.
4. Vanderbilt University Medical Center Braces for More Staff, Budget Cuts
Nashville, Tenn.-based Vanderbilt University Medical Center recently cut more than 300 members from its staff, and further budget and staff cuts are on their way at VUMC. VUMC officials have set a goal of saving $100 million in its new fiscal year, and an additional $150 million in the following fiscal year. These cost savings will be achieved through cutting costs in areas like supplies, facilities and contract improvements, and also through labor cuts like offering early retirement, leaving vacant positions empty, implementing a hiring freeze and instituting layoffs.
5. Baptist Health in Arkansas to Lay Off 170
Little Rock, Ark.-based Baptist Health laid off 170 employees. The system cited lower reimbursement, increasing charity care and bad debt as the reasons for the cuts.
6. Danbury, New Milford Hospitals Cut 116 Jobs
Danbury (Conn.) Hospital and New Milford (Conn.) Hospital's parent network, Western Connecticut Health Network, cut 116 jobs, resulting in 65 layoffs.
7. Excela Health to Lay Off 78
Greensburg, Pa.-based Excela Health is laying off 78 and leaving an additional 58 positions empty. Excela attributed the workforce reduction to lower patient volumes and revenue.
8. St. Joseph Health to Lay Off 37
Orange, Calif.-based St. Joseph Health plans to lay off 37 employees across two hospitals. The layoffs will affect 26 employees at Santa Rosa (Calif.) Memorial Hospital and 11 employees at Petaluma (Calif.) Valley Hospital.
9. Blue Mountain Health System Lays Off 16
Blue Mountain Health System, a two-hospital system with campuses in Palmerton, Pa., and Lehighton, Pa., laid off 16 employees and eliminated 13 empty positions. Additionally, the system cut the hours of seven employees, and senior management and department directors took a pay cut.
10. Providence St. Peter Hospital Cuts Number of Licensed Practical Nurses
Olympia, Wash.-based Providence St. Peter Hospital is laying off nine licensed practical nurses. The layoffs are part of an internal restructuring at the hospital. Officials decided a registered nurse with a certified nursing assistant could handle patient care in certain units.
August 15:
1. Maine Medical Center to Slash 225 Positions
Portland-based Maine Medical Center announced it will lay off 50 employees and eliminate 175 other positions. In addition to the eliminated positions and layoffs, 120 employees took an early retirement package.
2. Mountain States Health Alliance to Chop 200 Jobs
Mountain States Health Alliance in Johnson City, Tenn., is cutting 200 jobs through attrition. System officials pointed to shrinking revenues, tied to the federal sequester and lack of state officials' agreement over Medicaid expansion, as the reason for the workforce reduction.
3. WakeMed to Lay Off Hundreds, Close Nursing Home
WakeMed Health & Hospitals in Raleigh, N.C., is laying off more than 100 employees, mostly through the closure of a nursing home in Fuquay-Varina, N.C. WakeMed will also cut the jobs of 14 staff interpreters as it outsources its interpretation services. All together, WakeMed will lay off 111 employees.
4. Northside Medical Center in Ohio to Lay Off 77
Northside Medical Center in Youngstown, Ohio, an affiliate of ValleyCare Health System of Ohio in Youngstown, is laying off 77 employees.
5. Alameda Health System to Lay Off Dozens
Oakland, Calif.-based Alameda Health System prepared to lay off about 57 workers. The layoffs will affect employees at all seven of the system's locations, including a psychiatric hospital and wellness clinics.
6. Lowell General Lays Off 34
Lowell (Mass.) General Hospital laid off 34 workers. Twenty-nine of the affected employees held administrative positions, while the remaining five were nurses and caregivers.
7. Samaritan Medical Center Lays Off 23
Samaritan Medical Center in Watertown, N.Y., announced a workforce restructuring plan that will lead to 23 layoffs. Of the 23 employees who will be laid off, six are in management and 17 are in non-management positions. In addition to the layoffs, about 42 staff members will be reassigned to other jobs that are currently vacant.
8. Ukiah Valley Medical Center Cuts Jobs, Employee Hours
Ukiah (Calif.) Valley Medical Center eliminated six positions and is leaving five positions vacant. Additionally, five positions will have a reduction in hours.
9. Anna Jaques Hospital Lays Off 9 Workers
Newburyport, Mass.-based Anna Jaques Hospital laid off nine employees. The layoffs represent the loss of roughly six full-time equivalent positions.
10. Hancock Medical Center in Mississippi Lays Off 8
Bay St. Louis, Miss.-based Hancock Medical Center laid off eight employees and cut the hours of an unspecified number of other employees.
11. Orlando Health Layoffs Continue
Orlando Health confirmed more employees will be laid off as part of a restructuring the system announced in November. No specifics on how many employees would be laid off in this phase have been released.
September 4:
1. PeaceHealth to Slash 500 Jobs: Vancouver, Wash.-based PeaceHealth plans to eliminate 500 jobs throughout its system through layoffs, attrition and reduced hours. Most of the jobs being cut will be from two hospitals in southwest Washington State: Southwest Medical Center in Vancouver and St. John Medical Center in Longview. Of the 340 positions being eliminated from the two hospitals, 177 will be lost through layoffs.
2. King's Daughters Medical Center Lays Off 148: Ashland, Ky.-based King's Daughters Medical Center laid off 148 workers in support, administrative and supervisory positions. The workforce cuts were made due to declining patient volumes and reimbursement cuts.
3. Centra Notifies 124 Employees Affected by Layoffs: Lynchburg, Va.-based Centra notified 124 employees they will be laid off. By Sept. 5, 112 employees will have been laid off, and 12 more will be gone by the end of the year.
4. NorthShore to Lay Off About 100 Workers: Evanston, Ill.-based NorthShore University HealthSystem announced plans to lay off 1 percent of its workforce, roughly 100 people. The layoffs are part of an effort to "address redundancies and realign staff," according to a NorthShore memo.
5. Baptist Memorial Health Care Lays Off 23, With More Layoffs Coming: Memphis, Tenn.-based Baptist Memorial Health Care laid off 23 managers, and announced a second round of layoffs affecting 61 additional employees. Baptist pointed to increased charity care and lower reimbursements from the government as the reason for the first round of layoffs.
6. Arnot Health to Eliminate 83 Positions at St. Joseph's Hospital: Elmira, N.Y.-based Arnot Health announced it will eliminate 83 full-time equivalent positions at St. Joseph's Hospital in Elmira in September. Arnot Health is transitioning St. Joseph's to focus more on outpatient care, psychiatric and alcohol/drug addiction treatment, long-term care and chronic care. Some units will be closed or consolidated as part of the transition, leading to the elimination of positions.
7. HMA's Tennova to Cut 75 Jobs: Tennova Healthcare, based in Knoxville, Tenn., plans to lay off 75 employees in October. Affected employees work in one of the system's regional service centers in the Physicians Regional Hospital in Knoxville. Naples, Fla.-based Health Management Associates owns Tennova, and is consolidating the Knoxville regional service center into a center in Arkansas.
8. Mission Health to Lay Off Dozens, Cut Budget: Asheville, N.C.-based Mission Health plans to lay off about 70 employees and make other employee-related budget cuts. In addition to the layoffs, the system eliminated three vice president positions, did away with merit increases for 2014 and froze paid time off accruals, among other cuts.
9. Covenant Health to Lay Off 49: Covenant Health in Lubbock, Texas, plans to lay off 49 employees as part of a workforce reduction strategy. The layoffs stem from reduced reimbursements due to healthcare reform and the sequester's cuts to Medicare.
10. Columbus Regional Healthcare System Axes 4% of Workforce: Columbus Regional Healthcare System in Whiteville, N.C., eliminated 28 jobs, or 4 percent of its workforce. Ten of the 28 positions were vacant.
11. Windber Medical Center Restructures Workforce, Lays Off 19: Windber (Pa.) Medical Center laid off 19 employees and is leaving 11 positions vacant in an effort to reorganize its workforce in order to prepare for the future of healthcare. The layoffs are not linked to lower patient volumes. The workforce reorganization will create four new positions at WMC.
12. CHS' Crestwood Medical Center Lays Off 13: Huntsville, Ala.-based Crestwood Medical Center laid off 13 employees, about 1 percent of its total workforce. Affected employees were in administrative and support positions. Crestwood is owned by Franklin, Tenn.-based Community Health Systems.
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